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  • Community-Based Adaptations of the IHI Breakthrough Series Model
    typically brings together clinical and leadership teams from health facilities sometimes including community members A report published this month in an AIDS journal supplement on the use of quality improvement strategies to improve HIV care provides four examples of how the Breakthrough Series model was adapted to support community volunteer health workers to improve care deep in the community In their study authors describe how they successfully experimented with the Breakthrough Series model using community health workers as key change agents in improving delivery of care and retention in care In a test of the applicability of the Breakthrough Series model outside care facilities in three different countries community workers with limited literacy and numeracy skills were able to collect and use data to identify gaps and track progress In work led by Edward Moses from MaiKhanda in Malawi village volunteers were assigned responsibility for tracking pregnancies and ensuring that mothers and newborns attended care facilities before during and after delivery In a project supported by USAID ASSIST in Mozambique the existing village health committee served as the community based improvement team and coordinated the village s health improvement activities around postnatal prevention of mother to child transmission of HIV in breastfeeding mothers In South Africa IHI s 20 000 and Centre for Rural Health partners supported community volunteers to promote safe care practices for newborns and early referrals of sick babies And in Cape Town South Africa IHI faculty member Michele Youngleson used the Breakthrough Series model to scale up an innovative Medecins Sans Frontiers prototype of community based HIV care clubs for cohorts of patients on long term treatment see photo A community volunteer meets with a cohort of AIDS patients each month to facilitate a peer support meeting to promote adherence to medications and relieve burden of care from the clinic based system Mostly the adaptation of the Breakthrough Series model for use in community settings was straightforward However QI processes needed to be adapted to the literacy and numeracy skills of the providers and teams required additional support For data records collection and presentation of data required simplified tools In two projects teams tracked numerators and denominators in hand drawn tables and avoided using run charts Overall the Breakthrough Series model was successfully adapted for use in communities outside traditional clinical facility settings Tags Collaboratives IHI Breakthrough Series model Improvement Capability Preventing Mother to Child Transmission of HIV HIV AIDS Maternal and Child Health Africa Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your complaint Follow Me Subscribe Blog Archive 2016

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=150 (2016-02-01)
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  • The Graduation Speech No One Heard
    many people in Boston this Sunday is like any other Sunday But for those of us in this pavilion this ceremony marks the end of what we ve done each Sunday in recent memory prepare for our classes for the week ahead and dream of this day If you are like me a huge space now fills the place this work once occupied a space given to reflection and more than a little anxiety about what graduating means I find myself pondering what I will do next What will I accomplish What kinds of leaders will we all be John W Gardner a renowned scholar whose work I studied in my leadership class at Suffolk University wrote about the founding of the United States and the emergence of a generation of unrivaled leaders According to Gardner these leaders knew they were shaping history He wrote Leaders of the day were afflicted with no trace of fatalism They believed that the locus of responsibility was in them and saw themselves as shapers of the future While many of us may think that those extraordinary times called for extraordinary leaders and that our present times are unexceptional and our connections to these leaders of the past are tenuous at best we would be wrong We are living in an extraordinary time The founding fathers lived at the dawn of the industrial age We too live at the dawn of a new age of information and communication where all human knowledge is doubling every 13 months And the questions we face as a society questions of justice equity privacy and the issues that we must confront are no less compelling and no less revolutionary We are the extraordinary people living in these extraordinary times We are the shapers of the future Let us build upon the momentum we started here at Suffolk and remember this charge when things get tough because they will We ll likely fail more times than we can count But it s in our failures that we may learn our greatest lessons and achieve our greatest successes There are many tales some true and others legend of Abraham Lincoln s personal and professional hardships in the nearly 50 years before he became one of our nation s greatest presidents He lost numerous political races He had a nervous breakdown He failed at his business leaving him in years of debt Whether fact or fiction Lincoln s stories of success after repeated failure have always resonated with the American people Yet too often I believe that in our day to day lives we forget its significance More often than we should we take the path of least resistance and in our thousands of emails texts and Tweets we lose the creative spirit that urges us to try things differently no matter how likely we are to fail no matter how small those first improvements may be Lincoln s legacy embodies a persistence and resilience that we celebrate here today During

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=149 (2016-02-01)
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  • Palliative Care Across the Continuum: How to Improve Medically Complex Patient Care While Reducing Costs
    about how palliative care could bring value to ACOs Would you comment on that As we move toward shared savings models and look at the cost and quality of care we need to find a better way to care for very sick patients often at the end of their lives who use up a lot of health care dollars So how do we better manage this specific group of people That is what all ACOs everybody who s struggling with shared savings models and looking at quality based care are looking at And this is what we already do in palliative care we manage patients with multiple medical issues In the fee for service model palliative care was not seen as a money making operation Now however in a time when the better care for patients that gives them the health care they want is actually more financially feasible more and more health systems are making palliative care a priority Often when we ask What s important to you medically complex patients will say I don t want to be in the hospital If we can put structures in place like providing nursing care or services like housekeeping to help give these patients what they need in the home it keeps them out of the hospital which is really a win win because that s what patients want and it s what hospitals want as they face penalties for readmissions I think that is why the people who are thinking about how we pay for health care are really focusing on palliative care as at least a part of how we can manage our sickest patients The issue in finding a better way to care for these very sick patients however is that there are so few people who are trained to do it well That s why it s worth looking at the people who are already doing this kind of work in your organization for example geriatricians social workers physicians nurses nurse practitioners and others how do you pull them together and how do we get them to engage with their patients about what their wishes are How do we use vising nurse associations to increase the services they provide for these sick patients to help keep them out of the hospital Look within your own organization find the people who have these strengths and work on training them to provide better care What are the advantages of providing early palliative care Palliative care offers so many benefits to patients Multiple studies have shown that palliative care early in a serious diagnosis not only improves your quality of life which seems obvious since the goal is to improve pain and symptoms but it can actually help you live longer Beyond that palliative care will often help a person and their family think about what s most important to them and having those conversations about care early on can be so helpful Consider a young woman with a cancer

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=148 (2016-02-01)
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  • Residents Lead Quality Improvement Project to Improve Depression Screening in Diabetic Patients
    medical and psychiatric illness and we know that treating both requires a coordinated approach Fortunately CHA was already engaged in the Alice Rosenwald Mental Health Integration Initiative to improve mental health integration into our primary care clinic sites So we thought that choosing a project that related to broader institutional improvement efforts would allow us to understand how institutional change occurs and to leverage institutional resources and relationships to help our project succeed Our project aim was to improve annual screening for depression from 50 percent to 70 percent in all diabetic patients with resident primary care providers We used the PHQ 9 for these screenings OS How did you plan out your tests of change RH Since we had three different continuity clinics we saw this as an opportunity to try separate PDSA cycles at each of those clinics while all working on the same aim I ll tell you about the PDSA cycles we ran at my clinic Somerville Hospital Primary Care First we ran a learning PDSA cycle which was a focus group including medical assistants secretaries nurses and preceptors from the resident care teams During the focus group we drew the current process map for screening for depression in diabetic patients at our clinic Then as a group we identified three realistic PDSA cycles to run over the next three months These PDSA cycles were 1 Test if routine huddles or short meetings between residents and medical assistants to identify diabetic patients due for annual depression screening prior to a clinic session improved rates of screening 2 Test if standardizing roles in the process of documenting depression screening in the electronic medical record improved the accuracy of that screening s documentation 3 Learn more about the accuracy of PHQ 9 entry into the electronic medical record It s a multi step process and we thought perhaps the screenings were happening more often than they were recorded The team at the Windsor Clinic tested the theory that depression screening was being appropriately completed but not appropriately documented in the electronic medical record The team at the Cambridge Hospital Primary Care Unit identified flow related challenges unique to screening diabetic patients of resident physicians who had only one assigned exam room and invited medical assistants to introduce the screening tool to patients during triage OS How did you gain buy in from staff RH Although we were fortunate to be able to work on a project within the Mental Health Integration MHI initiative we still had to do a lot of work to recruit ambulatory quality leaders clinic level leaders and our primary care team staff We learned the critical lesson that quality improvement work absolutely requires partnering with important stakeholders at all levels Not only did we reach out to ambulatory quality directors and stakeholders engaged in the MHI initiative but also recruited clinic medical directors and preceptors to help sponsor the project at each site We also learned that having leaders committed to the project doesn

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=183 (2016-02-01)
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  • What Are Always Events?
    achieve reliability in person and family centered care delivery processes IHI s Always Events Framework An Always Event is a clear action oriented and pervasive practice or set of behaviors that Provides a foundation for partnering with patients and their families Ensures optimal patient experience and improved outcomes and Serves as a unifying force for all that demonstrates an ongoing commitment to person and family centered care Many in health care refer to The National Quality Forum s Serious Reportable Events as never events Few would disagree that incidents such as performing surgery on the wrong site or a death caused by a medication error are not only tragic and harmful but they should never happen Conversely there are care processes and behaviors that should always occur reliable implementation of evidence based care and the adoption of professional standards of practice to ensure safe high quality care A key distinction of an Always Event is that patients and family members have identified the event as fundamental to improving their experience of care A fundamental principle in co designing Always Events is to move from doing for patients to doing with patients Always Events are aspects of the patient experience that are so important to patients and family members that health care providers must aim to perform them consistently for every individual every time An Always Event must meet four criteria Important Patients and family members have identified the event as fundamental to improving their experience of care and they predict that the event will have a meaningful impact when successfully implemented Evidence based The event is known to contribute to the optimal care of and respect for patients and family members either through research or quality improvement measurement over time Measurable The event is specific enough that it is possible to determine whether or not the process or behaviors occur reliably This requirement is necessary to ensure that Always Events are not merely aspirational but also quantifiable Affordable and Sustainable The event should be achievable and sustainable without substantial renovations capital expenditures or the purchase of new equipment or technology This specification encourages organizations to focus on leveraging opportunities to improve the care experience through improvements in relationship based care and in care processes Some examples of Always Events aimed at improving care transitions and discharge are Always Use Teach Back an initiative created by the Iowa Health System now UnityPoint Health and the SMART Discharge Protocol developed by Anne Arundel Medical Center see the related tools posted on IHI org IHI s Always Events framework holds promise as an approach to accelerate improvement efforts aimed at enhancing patients and family members experiences of care The goal of the process is an Always Experience Effectively using the framework is a practical methodology for achieving this goal For more about Always Events check out these resources Always Events Getting Started Kit Video What Is an Always Event Tags Person and Family Centered Care Engage Patients and Families in Improvement Reliable Processes

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=146 (2016-02-01)
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  • Lessons Beyond Africa: Using the Project Fives Alive! Lessons Learned Guide
    Improvement Advisor Jane Taylor In this blog post she explains how she s been applying its guidance about large scale improvement to a range of work in a variety of settings The Lessons Learned from Ghana s Project Fives Alive guide has been incredibly useful to me For each chapter in the guide I made PowerPoint slides with vignettes for organizations with whom I m working and I am using these slides to plan spread work in primary care and in tertiary hospital systems For example I am helping the Surviving Sepsis Campaign with a spread strategy The project I m working on focuses on screening patients on medical surgical units for sepsis and responding appropriately The chapter in the guide on communication is proving particularly useful because it s helped us think about where we want to publish how often and what audiences we want to target We want to reach as many professional groups as we can so we are preparing presentations to the Society of Hospital Medicine and to the Society of Critical Care Medicine and considering other professional venues as well There is also great advice in the guide on creating a website with photos to serve as a resource and inspiration for those engaged in spread You will also find useful suggestions on how to communicate with stakeholders and targeting messages based on the audience As an Improvement Advisor I can never say enough about data and the chapters on using measurement and developing quality improvement capability are incredibly useful One piece of advice that particularly resonated with me is that each spread unit should collect the improvement data six months prior to focusing on spread What I like about this guidance is that it surfaces any data collection issues early in the work and provides a baseline for measurement helping the spread units understand where they are as they begin their work so they can set their ambitions for improvement Often it can take two or three months before teams are facile with data collection This advice will help set them up for success I bet you will find your own favorite chapters in Lessons Learned from Ghana s Project Fives Alive And like me you may find yourself forwarding a copy to friends colleagues and others you work with It is the most useful resource I have used in a couple of years Tags Improvement Capability Large Scale Improvement Quality Improvement Data and Measurement Project Fives Alive in Ghana Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=145 (2016-02-01)
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  • Improving Patient Flow: Enduring Issues, New Challenges
    where we first assess patients Rethinking triage may involve everything from analyzing the best time to get a patient into triage to redesigning the flow of people in and out of triage Some organizations are starting to merge triage right into the emergency department s direct care almost doing away with traditional triage since it s sometimes a potential bottleneck Often the ED team can identify likely admissions To improve flow there is an opportunity to start to locate inpatient beds on ED admission versus completion of ED work up and the formal decision to admit a patient to inpatient care How does the increasing emphasis on patient satisfaction scores influence the efforts to address flow issues A recent article in The Atlantic raised some troubling issues about how some hospitals overemphasis on patient satisfaction scores may be distracting organizations from improving the quality and safety of their care When organizations place such heavy emphasis around one component of quality care they risk not seeing the larger picture But it s easy to understand why health care organizations focus so heavily on the patients expectations because they get rewarded for getting high patient satisfaction scores Having said that the focus on patient satisfaction can also tell us a lot about the bottlenecks backups and other problems with flow Getting input from patients is important but it is only one piece of a bigger systems level view that helps us understand the many factors that impact quality and safety in an emergency department The 2014 AHRQ guide Impro ving Patient Flow and Reducing Emergency Department Crowding made the case for the importance of forming a multidisciplinary patient flow team Would you comment on that IHI recommends that a multidisciplinary improvement team includes a clinical leader technical expert a day to day leader and a project sponsor Additionally the AHRQ guide recommends paying particular attention to the roles played by registrars clerks and technicians as well as other ED support personnel They offer important perspectives that many overlook For day to day care nursing leaders play a pivotal system navigator role in emergency flow The emergency department is a place where multiple care providers typically tend to the patient so a nurse can create continuity as part of a multidisciplinary team approach Nurses can be an advocate and educator but also the coordinator of care Putting too much responsibility on just nursing however has potential challenges because of staffing When various demands pull nurses in too many directions if they re playing the coordinator role for the patient and they re not available the system slows down That s why it s important to have multidisciplinary team responsibility instead of individual responsibility How can improving flow in the ED potentially contribute to efforts to reduce unnecessary readmissions By improving ED flow there is a real opportunity to help reduce avoidable readmissions If you look at the data some of the biggest users of emergency departments are very often frail elders people with

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=144 (2016-02-01)
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  • 5 Tips for a Successful Chapter Event from Wright State University
    work with a simulated patient while nursing students place a peripheral IV in an interprofessional simulation hosted by the WSU Chapter in April 2014 If you re thinking about planning a similar meeting here are five things WSU did that could help you create a successful event Start at the beginning by introducing the Open School and QI The event at WSU opened with a video that explained the goal of the IHI Open School and another from the famous Dr Mike Evans about the history and concepts of quality improvement in health care Students seemed just as interested in the videos as they were with the pizza Brian said Share real projects to improve the quality of care Most students are drawn to QI because they want to make health care better So they were excited to hear about two quality improvement projects headed by physicians in the local health care system One project focused on reducing physician interruptions in the operating room Another implemented more strin gent screening tools to identify depression in diabetics among the urban population of Dayton Ohio When carrots don t work try sticks Upperclassmen in the audience told students that QI is an increasingly sought after skill set by employers and residencies Student doctors told the crowd that quality improvement projects are also a requirement of some residency programs Offer the opportunity to practice interprofessional teamwork Stu dents learned about the WSU Chapter s activity in the simulation lab where WSU medical and nursing students work with Cedarville University pharmacy students to rotate through a high fidelity very realistic simulation lab with a manikin patient WSU hosted this event after learning about a similar activity hosted by the IHI Open School Chapter in North Dakota Hooray Chapter network Free food Although not a requirement event organizers at WSU said the hot pizza helped draw student out on an especially cold and dreary day That s what IHI Open School event sponsorship is great for Brian and the other leaders of the Chapter thought this all came together nicely to help the Chapter with several of its goals recruitment teaching QI skills and raising awareness about the Chapter and QI in health care We were all very happy with the event and believe that events such as these are vital to the success of the Chapter he said Do you have any tips to add Feel free to let us know in the comments below Tags Chapter Network Chapter Activity interprofessional learning Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=182 (2016-02-01)
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